Robert J. Schwartz

The Economic Implications of Self-Care: The Effect of Lifestyle, Functional Adaptations, and Medical Self-Care Among a National Sample of Medicare Beneficiaries

OBJECTIVES Self-care includes actions taken by individuals to promote or ensure their health, to recover from diseases or injuries, or to manage their effects. This study measured associations between self-care practices (lifestyle practices, adaptations to functional limitations, and medical self-care) and Medicare expenditures among a national sample of adults 65 years and older. METHODS Regression models of Medicare use and expenditures were estimated by using the National Survey of Self-Care and Aging and Medicare claims for 4 years following a baseline interview. RESULTS Lifestyle factors (swimming and walking) and functional adaptations (general home modifications) were associated with reductions in monthly Medicare expenditures over a 12-month follow-up period. Expenditure reductions were found over the 48-month follow-up period for participation in active sports, gardening, and medical self-care. Practices associated with increases in expenditures included smoking, physical exercise (possibly of a more strenuous nature), and specific home modifications. CONCLUSIONS Certain self-care practices appear to have significant implications for Medicare expenditures and presumptively for the health status of older adults. Such practices should be encouraged among older adults as a matter of national health policy.

Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis

PURPOSE Social and economic contextual factors may promote concurrent sexual partnerships, which can accelerate population HIV transmission and are more common among African Americans than U.S. Whites. We investigated the relationship between contextual factors and concurrency. METHODS We analyzed past 12-month concurrency prevalence in the 2002 National Survey of Family Growth and its contextual database in relation to county sex ratio (among respondents racial and ethnic group), percentage in poverty (among respondents racial and ethnic group), and violent crime rate. Analyses examined counties with balanced (0.95-1.05 males/female) or low (<0.9) sex ratios. RESULTS Concurrency prevalence was greater (odds ratio [OR]; 95% confidence interval [CI]) in counties with low sex ratios (OR, 1.67; 95% CI, 1.17-2.39), more poverty (OR, 1.18; 95% CI, 0.98-1.42 per 10 percentage-point increase), and higher crime rates (OR, 1.04; 95% CI, 1.00-1.09 per 1000 population/year). Notably, 99.5% of Whites and 93.7% of Hispanics, but only 7.85% of Blacks, lived in balanced sex ratio counties; about 5% of Whites, half of Hispanics, and three-fourths of Blacks resided in counties with >20% same-race poverty. CONCLUSIONS The dramatic Black-White differences in contextual factors in the United States and their association with sexual concurrency could contribute to the nations profound racial disparities in HIV infection.

Pharmacist-Led, Interdisciplinary Model for Delivery of Supportive Care in the Ambulatory Cancer Clinic Setting

PURPOSE To describe a pharmacist-led, interdisciplinary method of care delivery begun at the University of North Carolina. We describe the characteristics of the population seen and the role of the individual members of the interdisciplinary team, and provide an early analysis of the programs impact on symptom improvement. METHODS A supportive care consultation service was begun at the University of North Carolina Hospitals to serve adult outpatients with cancer undergoing treatment or follow-up. Patients data were entered into an institutional review board-approved database to permit detailed assessments over time. Patient demographics were analyzed using descriptive statistics, medications used and changes made were noted, and symptom scores from a previously described instrument were captured and compared over time. RESULTS Patients were seen from all adult oncology services, including gynecologic, radiation, medical, and surgical. The characteristics of the population seen were similar to those of the hospital population as a whole. Most of the patients were seen for pain management, and many required a medication change. Symptom scores improved by the second visit, and the improvement was maintained. CONCLUSION We are able to demonstrate that the use of a pharmacist-led, interdisciplinary team produced an improvement in symptom scores comparable to what has been seen in the inpatient palliative care service within our institution. Projected shortages of oncology providers may be mitigated by pharmacists working in collaborative practices, with prescriptive authority, in the ambulatory oncology setting.